Psychosocial Stressors (PSS) of the Stroke Survivor

Written By: Dr. Ron Sheppard, OTD, OTR/L, C/NDT, FABDA

There are approximately 795,000 individuals having a stroke each year just in the United States alone, and it is classified as the fifth leading cause of death in the country.

As an Occupational Therapist with a certification in Neuro Developmental Treatment C/NDT, I don’t only address the physical effects caused by stroke, but also, the psychological. I would like to provide you with a noted, universal characteristic that is very important to address before the survivor can gain maximum improvement: I call this characteristic, Psychosocial Stressors (PSS).

What is PSS? They are the psychological reactions that a stroke survivor experiences following their stroke. They experience stressful situations and demands that extend well beyond their coping skills, such as financial difficulties due to medical bills from their caregiver and managing responsibilities with jobs, children, grandchildren, aging parents etc. Stroke survivors, and possibly their caregivers, are now unable to continue these responsibilities. The result is – additional stress being added to the debilitating effects of the stroke. Thus, their rehabilitation potential suffers.

As a new therapist 31 years ago, most of my clients with a diagnosis of stroke were retired, on fixed incomes with their homes paid off, no car payments, and their children out of the home etc.

Today, it is much different. Survivors are much younger. Every decade after age 55 the number doubles. In simple terms, that translates to the trend that 25%, or 198,750, of the 795,000 is now 65 and younger.

Younger patients with late effects of stroke, have different PSS than the older adult. My younger clients are concerned about paying for their children’s education, car payments, paying for their children’s marriages, returning to work, paying their mortgages, etc.

The stroke survivor doesn’t care what kind of wheelchair or walker you recommend to them, or if they can use other assistive devices, they are worried about paying their bills and maintaining family responsibilities, which I identify as PSS.

I realized early in my career that if I did not address my patient’s PSS during treatments, I noticed that my patients weren’t progressing to their fullest potential. PSS takes away their focus from successful rehabilitation and inhibits them from being motivated to do their Home Exercise Programs (HEP’s). It also increases feelings of giving up and depression sets in etc. Therefore, along with providing treatments consisting of strengthening, range of motion exercises (ROM), mobility/balance training, as well as the provision of assistive device training (i.e. tub chairs, wheelchairs, and walkers), I had to address the PSS that were preventing my patients from directing their total focus on recovery.

Regardless of your discipline or setting, all therapists involved in recovery can learn how to address PSS following stroke. Also, therapists can learn to keep the stroke survivor motivated and focus on their rehabilitation.

Here are a few ways I address my patient’s PSS: I asked if they attend a local church, and if they do, I will contact their church. Many church members will assist a stroke survivor free of charge. Some can become sitters, provide meals, do light housework, and even drive patients to doctor’s appointments. Also, some large churches have a medical staff, such as nurses, who can visit and assist with them with their medications, take vitals, etc. I would also find and identify a list of social workers in the area, as they are a great resource to assist with financial issues and educate those without insurance. Social workers have many connections with local and state agencies that can and will assist with those in distressed financial situations. People are also learning about how to create GoFundMe accounts to assist with the pressure of mounting medical bills. I have had many past patients with long-term disabilities create these accounts and have been successful with assistance. Also, social media accounts such as Facebook and Instagram can help survivors to reach out after posting a message to just let friends know about their current situation and progression of their PSS. If your friends and extended family aren’t aware of your needs, how can they assist?

As a stroke survivor, they have more to worry about than paying medical bills. They need less PSS so they can focus on their recovery.

Regardless of your discipline or setting, you can learn how I address PSS in my course, Evidence-Based Assessment and Treatment for Stroke Recovery. In this course, you will learn how to identify/address your clients’ specific PSS following Stroke while keeping them motivated and focusing on their rehabilitation.

About Ron:

Dr. Sheppard is an Occupational Therapist with 31 years of experience and developed 2 outpatient OT clinics specializing is adult/pediatric neurological disorders and orthopedic conditions. Dr. Sheppard has a certification in Neuro-Developmental Treatment C/NDT and teaches Evidence-Based Assessment and Stroke Recovery for Summit. He recently took a full time faculty position as a Clinical Associate Professor at Emory & Henry College of Health Sciences. Dr. Sheppard continues seeing private patients along with his college and Summit schedules.